OBESITY DILEMMA IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Since chronic obstructive pulmonary disease (COPD) is becoming the 3rd death cause worldwide, modern approaches are expected; Precision medicine is seen as the right approach in COPD management. An interesting paradox can be seen in COPD, overweight and mild obesity being associated with improved survival rate and a slower decline in lung function, lowest mortality risk is seen at BMI ~ 30 kg/m2. Then, shall we treat obesity or not ? this is the dilemma. But these protective effects seems to be valide only under BMI < 32 kg/m2, not above. Further guidelines are expected for obesity and COPD approach. Prospective medical nutrition therapy in COPD should prioritize : adapted caloric intake for long term maintainance of a BMI below 30 kg/m2, muscle mass maintainance by proteic intake at 1,2 g/ kgb/day and right macronutrient percentage : proteins 15-20%, lipids 30-45 %, carbohydrates 40-55%. Mediteranean Diet, physical activity in line with body training performances and smoking cessation will accompany long term healthy lifestyle recommended for these patients. In conclusion, healthy lifestyle recommendations as part of a pulmonary rehabilitation multidisciplinary intervention will lead to a healthy weight and better pulmonary outcomes.